Provider Demographics
NPI:1992272389
Name:MICHL, TEGAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:TEGAN
Middle Name:
Last Name:MICHL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 FITZSIMMONS DR
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1000
Mailing Address - Country:US
Mailing Address - Phone:253-968-2820
Mailing Address - Fax:
Practice Address - Street 1:NEUE AMBERGER STR
Practice Address - Street 2:
Practice Address - City:GRAFENWOEHR
Practice Address - State:BAVARIA
Practice Address - Zip Code:92655
Practice Address - Country:DE
Practice Address - Phone:314-590-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61035725103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical